To perform in the upcoming value-based healthcare market, providers across the spectrum will need to develop an advanced analytics strategy. In particular, Medicare Part B providers will need to prepare for Medicare’s new Merit-Based Incentive Payment System (MIPS), as more of their payments will be tied to performance measures that will likely start being tracked in 2017.
The looming implementation of the MIPS — part of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law on April 16, 2015 — will repeal the Medicare Part B Sustainable Growth Rate (SGR) and replace it with a consolidation of three existing programs beginning in 2017: Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM). This will magnify incentives and penalties for providers based on the performance measures of the three programs. Medicare Part B providers will receive scores in four performance categories that will be used to determine their Medicare reimbursement. These scores will be made publicly available on the Physician Compare website, giving visibility into how providers compare against their peers on a national level.
“This is a fundamental payment overhaul,” says Leslie Kriegstein, Vice President of Congressional Affairs at the College of Healthcare Information Management Executives (CHIME). “Folks are pointing to 2019, but that’s the first payment year. As things stand today, we are rapidly approaching the first program year of 2017. There is no rulemaking yet, and it’s still going to be a very expedited timeframe by the time we respond to those proposals and see them finalized. Folks will have to put the pedal to the metal after that.”
“This is a fundamental payment overhaul.”
Although MACRA was signed into law a year ago, healthcare providers remain unprepared for this drastic change in reimbursement. Industry experts, including the National Quality Forum, believe that MIPS will reveal gaps in reporting for patient-centered measures, including “patient-reported outcome measures, functional status measures, care coordination measures, and measures that incorporate patient values and preferences.
With Medicare and private payers tying reimbursements to value-based care in the very near future, health systems are in urgent need of advanced analytics. Enterprise data systems can take years to assemble and implement. But an agile, laboratory-based analytics platform can be up and running much more quickly — often in as little as six months. Learn more in our white paper, Agile Analytics: The Key to Surviving and Thriving After the Medicare Tipping Point.